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2017 HCHB_digital

Warts Warts are benign

Warts Warts are benign (non-cancerous) growths of skin caused by the human papillomavirus (HPV). More than 100 different subtypes of the HPV virus are known. The HPV virus causes the top layer of skin to grow rapidly forming a wart. The HPV virus is transmitted by direct skin-to-skin contact with other people with warts. Warts can also be spread to other parts of the body if they are picked or scratched and the viral particles are able to gain entry through a break in the skin barrier – this is called autoinoculation. Warts have a long incubation period and it may take up to 12 months after infection for the first wart to appear. Common warts typically occur on the backs of fingers or toes, less commonly on the elbows and knees. They may occur singly or in crops and are usually painless. Warts located around the nail bed may also distort nail growth. Some take on a cauliflower-like appearance with tiny black dots visible within the wart (these are thrombosed capillary blood vessels); these are known as butcher's warts. Plane warts tend to have a flat surface and may appear in a line since they are commonly inoculated by shaving or scratching. Filiform warts have a long stalk and more commonly occur on the face. Warts can also affect the oral cavity, particularly the tongue, inside surface of the cheeks, and lips. These are called oral squamous cell papillomas and are typically caused by virus types HPV-6 and HPV- 11. These subtypes are not usually cancerous but may be surgically removed for cosmetic reasons. Refer all customers presenting with oral cavity or anogenital warts to a doctor or dermatologist. For information on verrucae (warts on the soles of the feet – also called plantar warts) see Foot Care. Warts are common in children, with a peak incidence occurring in adolescents aged 12–16 years. Fifty per cent of cutaneous warts in children dissappear by themselves within six months without any treatment. More than 90% are gone in two years. Warts in adults tend to be more persistent, although most clear up eventually. People with Human Immunodeficiency virus (HIV) infection, or who take the immunosuppressant medicines azathioprine and cyclosporin are more likely to suffer from numerous warts that are difficult to treat. Initial assessment In a private area of the pharmacy, put on gloves and inspect the wart if it is on an exposed part of the body. If there are multiple warts, are they in a defined area or widespread? Refer the customer to a pharmacist if the lesion does not look typically wart-like, the patient appears to have a poor overall general health, or if they answer "yes" to any Refer to Pharmacist questions. Treatment Many people seek treatment either because the wart is painful or for cosmetic reasons if the wart is unsightly. Treatment options include chemical treatments containing salicylic acid or similar compounds which remove the dead surface skin cells and are effective in around 70% of cases although they may take up to 12 weeks to work. Even if the wart doesn’t go completely, products usually make the wart smaller and less uncomfortable. Podophyllotoxin is a cytotoxic TREATMENT OPTIONS Category Examples Comments Salicyclic/lactic acid Volatile hydrocarbons (home cryotherapy) Other products Natural / herbal products / supplements [PHARMACY ONLY] eg, Duofilm Wart Remover, Scholl Wart Remover system (fabric/washproof) [GENERAL SALE] eg, Wartie Wart Remover*, Warteze, Wartner Wart Remover, Scholl Freeze Verruca & Wart Remover [GENERAL SALE] eg, Wartfree Wart Remover Pen Homeopathic Thuja wart paint, Naturo Pharm Wartoff Paint/Tablets/Spray Garlic, green tea extract Products with an asterisk have a detailed listing in the Warts section of OTC Products, starting on page 267. Soak affected area in warm water and towel dry before applying product. Effectiveness may be improved by rubbing the surface with pumice stone or emery board to remove any hard skin. Daily treatment is necessary except for fabric-based systems which are changed every 48 hours. Contain ingredients that freeze the wart, such as dimethyl ether and propane. Usually just a one-off application of 20 seconds is needed; however, it may be repeated after 15 days. May be uncomfortable for a few minutes and may result in blistering. May take several repeat attempts over several months to completely get rid of the wart. There is no evidence to suggest this treatment is any more beneficial than other wart treatments; however, it may be more convenient. Typically contain corrosive ingredients that induce peeling of the surface of the wart. Homeopathic remedies aim to stimulate the immune system to attack the virus responsible for warts. Topical garlic has some effectiveness for warts. Effectiveness for a green tea extract ointment against genital and perianal warts has been reported. Page 166 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION agent which is a prescription medicine. It is more commonly used for anogenital warts and should not be used by pregnant or breastfeeding women. Cryotherapy is the process by which a wart is frozen repeatedly, at one to three week intervals with liquid nitrogen by a doctor or with over-the-counter products bought for use at home. The process may be uncomfortable for a few minutes and blistering of the area may occur. It also has around a 70% success rate. Other options include: • keeping the wart covered for 24 hours of the day (ie, with duct tape) • electrosurgery – performed for particularly large and annoying warts under local anaesthetic, although 20% of warts may recur • laser treatments. Advice for customers • Do not pick, bite or scratch warts since this may encourage spread to other parts of the body, and to other people. »» Never share razors as these can aid in the spread of warts. • If using a chemical wart paint, first, soften the skin in a bath or bowl of hot soapy water. »» Rub the hard skin away from the wart surface with a piece of pumice stone or emery board »» Cut a hole in a plaster or surround the wart with vaseline. Apply the wart paint or gel only to the wart and allow it to dry completely »» Cover the wart with plaster or duct tape (particularly recommended when the wart is on the foot) »» Stop treatment for a few days if the skin becomes sore, then recommence, paying particular attention to not getting the paint on unaffected areas of skin. • In general, keeping warts covered (ie, with duct tape) may help prevent spread. • Encourage patient compliance and persistence with regimens, since most warts take up to 12 weeks to treat. • Wear jandals when using public showers or walking around swimming pools since warts can be spread indirectly through wet surfaces particularly through scratches or cuts when barefoot. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, immunosuppression, diabetes, is pregnant or breastfeeding)? • Is the customer aged over 50 years? • Are the warts located on other parts of the body (eg, feet, face, genital region, oral cavity)? • Are there multiple or widespread warts? • Is the wart larger than 7mm in diameter? • Is there any itching or bleeding associated with the wart? • Does the wart have an irregular border? • Does the wart have pigmentation or a reddish colour or has it changed colour? • Does the wart look smooth or have a central dimple? • Has the wart grown recently? • Does the person have any allergies to topical medicines? • Are you or the customer unsure of the diagnosis? Read the label and follow the instructions. Wilson Consumer Products, Auckland TAPS NA8914 Page 167

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